Addressing the Health and Social Challenges of People Who Inject Drugs in Rwanda is a Public Health and Moral Imperative
Dr. Jean Olivier Twahirwa Rwema, 2021-2022 IIE Centennial Fellow
Access To Health Is a Human Right
The Universal Declaration of Human rights (UDHR) states that every human is entitled to the same rights and freedoms without any distinction based on race, color, sex, or any other status. 1 Specifically, the 25th article of the UDHR stipulates that “EVERYONE has the right to a standard of living adequate for the health and well-being of himself and of his family including food, clothing, housing, and medical care…”.1 Since then, the principle that health and access to quality medical care is a human right has been a guiding principle in health policy design by the World Health Organization and several other global health organizations.
Though a human-rights approach to health based on equity and non-discrimination has been a core principle of global health, racial and ethnic minorities, gender and sexual minorities, low-income individuals, and individuals with stigmatized behaviors still face substantial discrimination and have limited access to healthcare. Consequently, minority and marginalized groups generally have a poorer quality of life compared to other individuals in their communities. Due to this connection between health and human rights, it is now established that for optimal health and well-being of marginalized communities, health programs should be implemented alongside structural interventions including those to mitigate stigma, to reduce violence, and to promote social justice.
My IIE Centennial Fellowship uses a human-rights lens to further evaluate the health and social needs of People who Inject Drugs (PWID) in Kigali, Rwanda, to inform health programming for this group in Rwanda.
Why People Who Inject Drugs?
Globally, People who Inject Drugs have a substantial burden health and social challenges. In fact, injection drug use (IDU) is associated with an increased acquisition and transmission risk of severe infections including HIV and viral hepatitis. At the same time, PWID experience structural factors including stigma, discrimination, criminalization, and high exposure to human rights abuses in all regions of the world. 2 This social exclusion limits their engagement with healthcare services which results in PWID having poorer health outcomes compared to other adults. 3 Furthermore, PWID also face significant social and economic challenges including high burden of homelessness or unstable housing, high incarceration rates and experience mental health issues. 4
In Rwanda, PWID have largely been overlooked in HIV and viral hepatitis programming and research. Currently, there is no minimum package of health services implemented for PWID in Rwanda. 5 Generally, the world health organization recommends to countries to offer a range of health services to PWID including harm reduction services like needle and syringe services. 6 This lack of PWID-focused national programming, coupled with the criminalization of drug use or possession, further complicates programming in Rwanda. 7 However, we recently demonstrated that IDU was an increasing social phenomenon in Kigali, that PWID in Rwanda had a higher burden of HIV compared to the general populations, and exhibited behaviors that increase their risk of blood-borne infections. 8 PWID in Rwanda also experience social challenges experienced by PWID in other regions of the globe, with many living in poor conditions. Thus, understanding and addressing the needs of PWID in Rwanda is a public health and human rights imperative.
What I Hope to Achieve with The Project
The goal of my IIE Centennial Fellowship project is to lay the foundation on which to build stronger health and social programs that will promote the well-being and social justice for PWID in Rwanda.
First, the project will generate additional epidemiological data on HIV, sexually transmitted infections, and viral hepatitis among PWID in Kigali. The project will also provide prevention services including HIV and viral hepatitis testing and linkage to care to PWID eligible for treatment of any of these infections, hepatitis B virus vaccination, and linkage to addiction treatment services. All these services will be provided free of charge. This will provide valuable information to guide prevention and treatment programs of these infections among PWID in Rwanda. Second, we will go beyond infectious diseases and assess the burden of additional health challenges including mental health. Finally, the project will also assess stigma experiences and living conditions of PWD in Rwanda.
Ultimately, by simultaneously assessing health and social challenges of PWID, this project has the potential to provide comprehensive recommendations that will not only promote the quality of life for PWID, but also a benchmark on which to design social justice and human right promotion programs for them.
- United Nations. Universal Declaration of Human Rights. In:1948.
- Jürgens R, Csete J, Amon JJ, Baral S, Beyrer C. People who use drugs, HIV, and human rights. The Lancet. 2010;376(9739):475-485
- Malta M, Ralil da Costa M, Bastos FI. The paradigm of universal access to HIV-treatment and human rights violation: how do we treat HIV-positive people who use drugs? Curr HIV/AIDS Rep. 2014;11(1):52-62.
- Degenhardt L, Peacock A, Colledge S, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. The Lancet Global Health. 2017;5(12):e1192-e1207.
- Health Mo. National Guidelines for Prevention and Management of HIV. Kigali, Rwanda: Ministry of Health – Rwanda Biomedical Center; 2016 2018.
- WHO. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva, Switzerland: WHO; 2016 2016.
- UNAIDS. 2021 Global AIDS Update — Confronting Inequalities. UNAIDS;2021.
- Twahirwa Rwema JO, Nizeyimana V, Prata NM, et al. Injection drug use practices and HIV infection among people who inject drugs in Kigali, Rwanda: a cross-sectional study. Harm Reduction Journal. 2021;18(1).